Illustrative Photo (VSS)

The Document states that, implementing the Law on Health Insurance, the Government’s Decree No 146/2018/NĐ-CP dated October 17, 2018, elaborating and providing guidance on measures to implement certain articles of the Law on Health Insurance and the Government’s Decree No 75/2023/NĐ-CP dated October 19, 2023, amending and supplementing some articles of Decree 146  146/2028/NĐ-CP, Vietnam Social Security (VSS) instructed provincial social security offices to carry out the signing of health insurance-based medical examination and treatment contracts as follows:

First, to continue to implement the signing of health insurance-based medical examination and treatment contracts as guided by the VSS in Document No 4076/BHXH-CSYT dated December 13, 2021, Document No 3794/BHXH-CSYT dated December 12, 2022, and the Medical Review Procedure issued with Decision No 3618/QĐ-BHXH dated December 12, 2022.

Second, to request the director of the provincial Social Security Office to assess and decentralise the signing of health insurance-based medical examination and treatment contracts by district-leveled social insurance offices in line with regulations stipulated in Point h, Item 4, Article 6 of the VSS General Director’s Decision No 2355/QĐ-BHXH dated September 16, 2022 which defines the function, duty, authority and organisational structure of local social security offices.

Third, the content of health insurance-based medical examination and treatment contract accords to Form No 7 Appendix issued with Decree No 75/2023/NĐ-CP. The Provincial Social Security Office must work with local facilities providing health insurance-based medical examination and treatment services to add some contents to the Contract in line with legal regulations.

Illustrative Photo (internet)

Fourth, to assess the necessity of the signing of health insurance-based medical examination and treatment contracts with new medical facilities based on the general situation of health insurance-based medical examination and treatment in the locality (the number of medical facilities that have signed contracts to provide health insurance-based medical examination and treatment services, overloaded medical examination and treatment, the ability to satisfy health insurance card holders’ demand for healthcare services, increased number of health insurance card holders, etc.), the use of assigned budget estimates for health insurance-based medical examination and treatment. The director of the provincial Social Security Office is responsible for signing health insurance-based medical examination and treatment contracts with new medical facilities.

Fifth, implement health insurance-based medical examination and treatment contracts:

a) To proactively work with the local Health Department in: Determining healthcare facilities registered for initial health insurance-based medical examination and treatment services in the province; Defining subjects, structure of subject groups, the number of health insurance card holders registered for initial health insurance-based medical examination and treatment at healthcare facilities in line with the actual conditions of the locality and the local healthcare facilities’ capacity to provide services; Providing guidance on transferring health insurance-based medical examination and treatment routes among medical facilities; Providing guidance on registering or changing the medical facility which health insurance card holders registered for initial health insurance-based medical examination and treatment services in accordance with articles 13 and 14 of the Ministry of Health’s Circular No 40/2015/TT-BYT dated November 16, 2015 defining regulations on the registration of initial health insurance-based medical examination and treatment and transferal of medical examination and treatment routes from an inferior to a superior facility and the VSS’ Document No 3637/BHXH-CSYT dated November 29, 2022.

b) To thoroughly review and verify the contract documentation to ensure full compliance: Operation licences, the person responsible for professional activities at the medical facility, hospital classification decision, location of the medical facility, registered medical practitioner, and so on. In case of any changes or expiration, the medical facility is required to provide complete supplementary documents according to regulations.

c) To work with the medical facility and have a detailed account determining the number of beds and healthcare personnel as required at the medical facility, ensuring compliance with the provisions at points c and d, Clause 1 Article 8 of the Ministry of Health’s Circular No 13/2023/TT-BYT dated June 29, 2023, which regulates the price framework and methods for determining the prices of on-demand healthcare services provided by the State-owned medical facilities.

d) To reinforce the inspection of the quality of healthcare services at medical facilities according to regulations stipulated at point a, Clause 4, Article 9 of the Ministry of Health’s Medical No 22/2023/TT-BHYT dated November 17, 2023. Please note that clinics and hospital rooms must use air conditioners to serve patients if they are already included in the structure of healthcare service prices. It is requested that healthcare facilities ensure the workforce in accordance with regulations stated in Article 3 of the Ministry of Health’s Circular No 03/2023/TT-BYT dated February 17, 2023, which guides job positions, workforce quantity, and staffing structure according to professional titles in public healthcare units./.